GAE Candidate Screening

If chronic knee pain from osteoarthritis is affecting your daily activities, Genicular Artery Embolization (GAE) may be a minimally invasive treatment option worth exploring. Please complete the screening form below. A member of our clinical team will review your information to help determine whether a consultation may be appropriate.

GAE Candidate Screening

Patient Contact Information

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1 - Patient Contact Information

Name*
Name*
Phone Number*
Date of Birth*
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Email Address*
Address*
Address*

2 - GAE Screening Questions

Have you had knee pain for more than 3 months?
Have you had knee pain for more than 3 months?
Have you received a diagnosis of osteoarthritis?
Have you received a diagnosis of osteoarthritis?
Have you received a diagnosis of osteoarthritis?
Have you received a diagnosis of osteoarthritis?
Does your knee pain limit your activities such as walking, climbing stairs, or standing?
Does your knee pain limit your activities such as walking, climbing stairs, or standing?
Have you tried conservative treatments such as NSAIDs, injections, or physical therapy?
Have you tried conservative treatments such as NSAIDs, injections, or physical therapy?
Are you considering alternatives to knee replacement?
Are you considering alternatives to knee replacement?

Schedule a Consultation

Fill out this form or call
239-344-7061 today!

Schedule A Consultation

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Fort Myers
8010 Summerlin Lakes Dr., Suite 100
Fort Myers, Florida 33907

Cape Coral
1003 Del Prado Blvd., Suite 303
Cape Coral, Florida 33990

Phone: (239) 344-7061
Main Office: (239) 939-1767
FAX: (239) 939-5895

Office Hours:
Monday – Friday: 8am – 5pm

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